Table 7 Benefit package design
Country | Scope of benefit package | |
|---|---|---|
Services covered | Compared to regularly insured population | |
Cambodia: | ||
HEFs | District referral hospital medical services, transport costs from health centre to referral hospital, food for patients and carers, sometimes funeral costs [29] | n/a |
SUBO | Outpatient and inpatient services at health centre level, inpatient only at national hospital, national centres and referral hospital level [30], user fees [40] | n/a |
China: | ||
URBMI | Inpatient care and critical outpatient care for accidents or limited chronic/fatal diseases (coronary heart disease, renal haemodialysis) [14] No preventive care More services covered in richer coastal cities [42] | Local governments determine financing level and details of arrangements. Less than UEBMI: no Medical Savings Account, most outpatient services are not covered except for very few selected diseases [14] |
NRCMS | Inpatient and outpatient services in about 70 % of NRCMS counties, only inpatient services in the other 30 % Listed drugs (approx. 400) [78] There are 4 models of how NRCMS operates throughout China: Model I (in place in 17 % of counties): Inpatient services only Model II (in place in 11 % of counties): Inpatient services and outpatient services for catastrophic diseases (separate deductibles and reimbursement caps) Model III (in place in 7 % of counties): Inpatient services according to a formula, outpatient services and preventive care according to specific formula through collective funds (usually no deductible and reimbursement cap) Model IV (in place in 65 % of counties): Inpatient services according to a formula, outpatient services and preventive care paid through household medical savings account (with deductible and reimbursement cap) [90] | Less than UEMBI [78] |
India: | ||
RSBY | Mainly inpatient secondary care: inpatient services on a “day care” basis (subject to sub-limits), transport allowance; pre-existing conditions (minimal exclusions) and maternity covered, care delivered in network hospitals including private hospitals (free choice); recently outpatient consultations [74] Public transport costs up to Rs. 100 per visit and Rs. 1000 per year, post hospitalisation drugs for 5 days [91] | Less: ceiling, no out-patient services, no medicines as in CGHS, no preventive and wellness care and no compensatory cash benefits for loss of wages in case of illness or maternity (ESIS) [24] |
Yeshasvini | Inpatient secondary and tertiary care: all inpatient charges associated with 823 specified surgical procedures (except transportation) excluded are certain high tech procedures No follow-up investigation; no diagnostic-test for non-surgery-related issues, no medicines Included outpatient consulting at a network of hospitals, since 2007 out-door treatment for stabilization of specific medical emergencies, normal deliveries and paediatric care during first 5-days of live, angioplasty procedure [92] | Less: ceiling, no medicines, no preventive and wellness care (all compared to CGHS) and no compensatory cash benefits for loss of wages in case of illness or maternity (ESIS) [24] |
Rajiv Aarogyasri | 938 hospitalization procedures (surgical and medical), largely tertiary care and some secondary care [24] | Less: ceiling, no out-patient services, no medicines as in CGHS, no maternity, no preventive and wellness care and no compensatory cash benefits for loss of wages in case of illness or maternity (ESIS) [24] |
Kalaignar | Inpatient tertiary care (626 surgical procedures) [12] | n/a |
Vajapayee Arogyasri | Inpatient tertiary care including 402 predefined packages and 50 follow-up packages [12] | n/a |
Indonesia | Free outpatient primary care in local health centres and third class public hospital inpatient services (registration required) including preventive measures and maternity at public and private (only few) providers [93] No annual physical check-ups, dental prostheses, fertility treatment, indirect costs (e.g. transportation) [60] | Less: Askes and Jamsostek include additional annual physical check-up, under Jamsostek more private providers but larger exclusions of conditions [60] As of 2012, Jamsostek also covers catastrophic cases. [33] |
Mongolia | Outpatient services at secondary and tertiary care levels; since 2010 outpatient diagnostic test up to 30 000 MNT per case per month; curative and palliative inpatient care, rehabilitation and long-term care; part of outpatient prescription drug expenses if on National Essential Drug list [88] | n/a |
Philippines | Outpatient care, inpatient cute care, emergency care, day surgeries, inpatient care in accredited hospitals [35] | More: outpatient care [35] |
Thailand | (Curative and preventive) outpatient and inpatient health services, rehabilitation, certain high-tech medical services (radio- and chemotherapy) but not all, prescription drugs on a national list Beneficiaries must follow the referral system (gatekeeper) to obtain free care Services usually at District Health System (district health centres and hospitals), except for emergencies/accidents [94] | Less than CSMBS More than SSS [36] |
Vietnam | All ambulatory and hospital basic, advanced diagnostic curative health services and therapeutic services (including high-tech medical services), referral for higher level services required, drugs inside reimbursement list, transportation costs in case of referral No occupational diseases, medical aid devices, rehabilitation or home care [15] | Same [15] |